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General NPI Number Information
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NPI Number | 1053779488
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Entity Type | Organization
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Legal Business Name | FIBROMYALGIA FOCUS, INC
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Dates
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Enumeration Date | 01/30/2016
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Last Update Date | 02/13/2017
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Provider Practice Location Address
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Address Line | 1675 SW MARLOW AVE SUITE 210B
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City | PORTLAND
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State | OR
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Zip | 97225-5104
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Country | US
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Telephone | 503-389-3106
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Fax | 503-546-4223
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Provider Business Mailing Address
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Address Line | 1675 SW MARLOW AVE STE 210B
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City | PORTLAND
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State | OR
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Zip | 97225-5162
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Country | US
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Telephone | 503-389-3106
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Fax | 503-546-4223
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MRS. CHERYL ANN HRYCIW
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Credential | MS, FNP
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Telephone | 971-344-8600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 200150080
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License Number State | OR
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